Information for women – Third and Fourth Degree Perineal Tears Clinical Care Standard

This standard supports a woman-centred approach, so women are informed about their risk of a third or fourth degree perineal tear and supported to make decisions and provide informed consent for the care they receive during pregnancy, labour and birth.

Third and fourth degree perineal tears: A video for women

Webcast video recording – Launch 

The Commission hosted a webcast to launch the standard on 21 April 2021.

The launch and panel discussion hosted by Professor Anne Duggan, Acting Chief Medical Officer, provides an overview of the new standard, and discusses some of the evidence driving the need for change.  

Expert panellists include obstetrician Associate Professor Emmanuel Karantanis, midwifery expert Professor Hannah Dahlen, physiotherapist Natalie McConochie, and Janelle Gullan, a woman who experienced a third-degree perineal tear. 

What is a perineal tear?

A perineal tear is an injury to the perineum, which is the area between the vagina and anus.

During labour, the skin and muscles around your vagina stretch to allow your baby to be born. Sometimes the area between your vagina and anus (the perineum) gets torn. This is known as a perineal tear.

Perineal tears are common and most heal well either naturally or with stitches. Some perineal tears are more serious and require surgical repair.

Tears are usually graded by ‘degrees’ from one to four according to how much of the area is affected.

Type of tear

Where it occurs


First degree

Skin of the perineum

May need stitches

Second degree

Muscles of the perineum

Usually need stitches

Third degree

Muscles controlling the anus

Surgical repair

Fourth degree

Lining of the anus

Surgical repair


The diagram below shows the areas affected by a perineal tear

A picture of degrees 1-4 of perineal tears


How many women are affected by a third or fourth degree perineal tear?

Third or fourth degree perineal tears affect:

  • Around 3 out of 100 women giving birth vaginally
  • Around 5 out of 100 women giving birth vaginally for the first time.

Most women who sustain a third or fourth degree perineal tear recover well with appropriate treatment and support, although some will need specialised care to optimise their recovery.

While not all third and fourth degree perineal tears can be prevented, it is possible to reduce the risk of their occurrence.

What does this standard mean for you?

This national standard describes best practice care for the prevention, recognition and management of third and fourth perineal tears. Find out what the Third and Fourth Degree Perineal Tears Clinical Care Standard says and what it means for you in the statements below. Reading these statements will inform your discussion with your healthcare professional.

Consumer guide to the clinical care standard

Download information resources for women

A number of resources have been developed to support the Third and Fourth Degree Perineal Tears Clinical Care Standard.